Breast Dz Flashcards Preview

Q4 Women's Health > Breast Dz > Flashcards

Flashcards in Breast Dz Deck (42):
1

High risk factors for breast CA (BCA)? (6)

65+yo
Atypical hyperplasia (confirmed)
BRCA genes
Lobular CA
Dense breasts
Hx/FHx (early ages)

2

Medium risk factors for BCA? (3)

Postmeno high E2/testost
Chest radiation
Hx/FHx

3

Best time for exam?

Follicular phase (closer to hormonal baseline)

4

Key features of breast exam?

Systematic approach
Cover entire area

5

Mammography views:

Screening?

Diagnostic?

2 craniocaudal (CC), 2 mediolateral oblique (MLO)

CC, MLO and other

6

US used when? (5)

Inconclusive mammo
Young W
Dense breasts
Better diff b/w solid or cystic mass
Guiding needle bx

7

MRI used when? (3)

Detection in high risk pts
Staging
NOT for mass eval

8

Before MRI gadolinium dye used, check what?

Check baseline BUN, Cr
Contra for renal dz

9

Fine Needle Aspiration Bx used when?

Initial eval of mass w/ low pretest CA probability

10

Core Needle Bx used when?

get sample of larger/solid mass

11

Mastalgia is?

Types?

Benign breast dz -> pain in the breast

Cyclic:
Luteal phase bilateral, diffuse pain
Fibrocystic ∆s

Noncyclic:
Unilateral or focal
(P) 2° to meds (hormones, SSRI, spirono)

12

Mastalgia Management? (3)

(P) US or mammo
Non-steriod anti-inflamm
Danazol or tamoxifen if persistent

13

Mastitis is?

Most C in?

Most C cause?

Infection in breast

Lactating W

S. aureus

14

Mastitis presentation?

DDX?

hard, red, painful, swollen area

engorgement, galactocele, abscess, inflamm BCA

15

Mastitis Tx?

Dicloxacillin or cephalexin
Keep breastfeeding

16

Nipple d/c: Pathologic causes?

Presentation?

INTRADUCTAL PAPILLOMA
duct ectasia (dilation), CA, infection

Spontaneous, unilat
Bloody, serous or clear
a/w mass

17

Nipple d/c: Physiologic causes?

Presentation?

Neurogenic stim
Meds: antihypTN, GI, hormones, opiates, psych

Bilat, multiduct
a/w stim

18

Benign Breast Mass characteristics? (5)

Discrete margins
No skin ∆s
Smooth
Soft or firm
Mobile

19

Malignant Breast Mass characteristics? (5)

Poorly defined margins
(P) skin ∆s
Hard
Immobile
Fixed

20

Breast Cysts characteristics? (6)

Benign
U 35-50yo
Fluid-filled round/oval mass
∆s w/ hormone flux
Firm
+/- tender

21

Cyst management?

Simple: none

Complicated (<1% malig): Fine Needle Asp (FNA), imaging

Complex (1-23% malig): bx, excision

22

Fibroadenoma characteristics? (5)

Benign
Solid, gland/fiber tissue
(P) ∆ w/ preg/E2
Firm
- tender

23

Fibroadenoma management? (4)

Core needle bx

OR If US look benign, no bx. Repeat exam and US in 3-6 mo

(P) Excision/ablation

If ↑ size, EXCISION

24

BCA presentation? (5)

1) Nonpalp (suspicious mammo)
2) Palp mass (most C)
3) Skin ∆s
4) D/C
5) Metastatic spread

25

Invasive BCA: Ductal?

Most C breast malig (80%)
U palp mass or mammogram abnormality

26

Invasive BCA: Lobular?

More likely bilateral
No microcalcifications
U palp mass or mammo abn

27

Paget's Disease of the Breast (PDB) characteristics? (7)

Rare
Scaly, raw, vesicular, ulcerated lesion,
Starts on nipple, spread to areola
+/- bloody d/c
U unilat
(P) Pain, burn, pruritis present before dz
MOST HAVE UNDERLYING BCA (in situ or invasive)

28

Inflammatory BCA characteristics? (6)

Very aggressive
Very rare
Pain w/ rapid tender, firm enlargement,
Warm, thick skin w/ erythema, orange peel
Most w/ LN involvement
1/3 w/ distant metastasis

29

BCA surgery based on? (7)

1) Tumor size
2) Metastases
3) LN involvement
4) E2 and PR status
5) Her2 NEU status
6) Oncotype recurrent score
7) BRCA status

30

Breast-Conserving Surgery (BCS): Lumpectomy is?

Used when?

Removal of portion w/ or w/o axillary node bx

For Stage I or II
w/ Postop radiation

31

Mastectomy types? (3)

1) Simple/Total: entire
2) Modified Radical: entire + axillary LNs
3) Radical: entire + ax LNs + pect mm

32

Radiation types? (3)

1) External beam (5-7 wks)
2) Brachytherapy (wires in tumor)
3) To breast, chest, region LN, axilla

33

Chemo used when? (5)

Primary and metastatic BCA,
Almost all w/ + lymph nodes,
High onco score (+E2/LN-)
Neoadjuvant (before surgery)
Adjuvant (after surgery)

34

Endocrine therapy used when?

Types? (2)

Receptor Status = E2 and PR
Supplement to chemo/radiation
E2+ more responsive than E2-

SERM: Tamoxifen x 5yrs
Aromatase Inhib: Arimidex

35

Her2/NEU Overexpression?

Tx used when/how?

1 in 5
CA grows faster and reoccur

Effective in early stages, metast dx
Herceptin target Her2 protein
Herceptin + chemo

36

Metastasis: Lymphatic spread

Axillary -> internal mammary -> supraclavicular (too late)

37

Metastasis: Hematogenous

Lungs/liver -> bone, ovaries, brain

38

BRCA genes are?

BRCA+ mgmt?

tumor suppressors

watch, chemoprophy or surgical prophy

39

BRCA 1 risks?

44-78% BCA by 70
24-40% ovarian CA by 70

40

BRCA 2 risks?

33-54% BCA by 70
8-18% ovarian by 70
6% male CBA

41

BCA f/u?

Hx/PE Q 3-6 mo x 5yrs, then annually

Initial mammo @ 6 mo post radio

Annual mammo if remaining breast

42

Chemoprevention?

Recommended for at risk 35+ w/o prior BCA dx